BACKGROUND: In female basketball athletes Anterior Cruciate Ligament (ACL) injury is the most frequent lower limb injury. Because it is very difficult to get a clear picture of the risk inherent in elite female Italian basketball players, we designed an observational study with a retrospective case-series design with the aim to investigate the incidence of ACL injury in elite Italian basketball league.METHODS: Thirty-two professional female basketball teams (n=352 players) participated to the study. Using a retrospective questionnaire for ACL injury data collection players had to report their demographic, training and occurred injuries data.RESULTS: A total of 74 ACL lesions were reported with 65 basketball players (18.4%) that had a complete rupture with surgical intervention. Seven players (9.4%) suffered from 2 or more lesions. The average of first ACL lesions was 20±4 years. The most of ACL injuries occurred during practice (n=54, 72.9%) compared to training (n=20, 27.1%), The higher ACL lesion occurred in the second round of national championship (n=31, 41.8%). ACL lesions were non- contact (58, 78.3%) and with contact (16, 21.6%) were and frequently occurring during turning movements (19, 43.1%).CONCLUSIONS: This observational study with a retrospective case-series design provided information about ACL injuries in Italian female basketball players during their career. Professionals had to identify soon the different risk factors for ACL injury in order to provide prophylactic intervention to reduce the incidence of ACL injuries in Elite female Italian professional league.